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Can We Predict Immediate Outcome After Laparoscopic Splenectomy for Splenomegaly? Multivariate Analysis of Clinical, Anatomic, and Pathologic Features After 3D Reconstruction of the Spleen

Service of Surgery, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

E.M. Targarona, MD, PhD

Service of Surgery, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain, etargarona{at}santpau.es

C. Balague, MD, PhD

Service of Surgery, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

J.C. Pernas, MD

Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

J.L. Pallares, MD

Service of Surgery, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

I. Gich, MD

Epidemiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

M. Trias, MD, PhD

Service of Surgery, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

The laparoscopic approach is the treatment of choice for splenectomy, but its definitive role in splenomegaly is controversial. Factors that influence immediate outcome are clinical, anatomic, and pathological. The aim of this study was to evaluate the predictive factors on outcome after laparoscopic splenectomy in splenomegaly. We reviewed patients submitted to laparoscopic splenectomy with a final spleen weight superior to 700 g. Three-dimensional reconstruction of the spleen was performed, and spleen volume and diameters were measured. Multivariate analysis showed that factors that predicted for conversion were mediolateral diameter ( P = .039, RR: 1.43) and platelet count (P < .05, RR: 1). For intraoperative bleeding, the predictive factor was spleen volume (P < .03, RR: 1.003). Anteroposterior spleen diameter was related to operative time (P = .011), and the factor related to postoperative morbidity was age (P = .049, RR: 0.941). Local anatomy and clinical factors affect surgical outcome in laparoscopic splenectomy for splenomegaly. These factors should be taken into account when planning this kind of procedure.

Key Words: 3D reconstruction • hand-assisted laparoscopic surgery (HALS) • spleen • laparoscopy • splenectomy • splenomegaly

References

• Targarona EM, Balague C., Berindoague R., Martinez C., Hernandez P., Trias M. Laparoscopic splenectomy in massive splenomegaly. European Surgery. 2007;38:176-182.
• Terrosu G., Baccarani U., Bresadola V., Sistu MA, Uzzau A., Bresadola F. The impact of splenic weight on laparoscopic splenectomy for splenomegaly. Surg Endosc. 2002;16: 103-107.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Nicholson IA, Falk GL, Mulligan SC Laparoscopically assisted massive splenectomy. A preliminary report of the technique of early hilar devascularization. Surg Endosc. 1998;12:73-75.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Hellman P., Arvidsson D., Rastad J. HandPort-assisted laparoscopic splenectomy in massive splenomegaly. Surg Endosc. 2000;14:1177-1179.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Greene AK, Hodin RA Laparoscopic splenectomy for massive splenomegaly using a Lahey bag. Am J Surg. 2001;181:543-546.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Heniford BT, Park A., Walsh RM, et al. Laparoscopic splenectomy in patients with normal-sized spleens versus splenomegaly: does size matter? Am Surg. 2001;67:854-857.[Web of Science][Medline] [Order article via Infotrieve]
• Kercher KW, Matthews BD, Walsh RM, Sing RF, Backus CL, Heniford BT Laparoscopic splenectomy for massive splenomegaly. Am J Surg. 2002;183:192-196.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Patel AG, Parker JE, Wallwork B., et al. Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg. 2003;238:235-240.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Mahon D., Rhodes M. Laparoscopic splenectomy: size matters. Ann R Coll Surg Engl. 2003;85:248-251.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Smith L., Luna G., Merg AR, McNevin MS, Moore MR, Bax TW Laparoscopic splenectomy for treatment of splenomegaly. Am J Surg. 2004;187:618-620.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Choy C., Cacchione R., Moon V., Ferzli G. Experience with 7 cases of massive splenomegaly. J Laparoendosc Adv Surg Tech A. 2004;14:197-200.[Web of Science][Medline] [Order article via Infotrieve]
• Kaban GK, Czerniach DR, Cohen R., et al. Hand-assisted laparoscopic splenectomy in the setting of splenomegaly. Surg Endosc. 2004;18:1340-1343.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Ailawadi G., Yahanda A., Dimick JB, et al. Hand-assisted laparoscopic splenectomy in patients with splenomegaly or prior upper abdominal operation. Surgery. 2002;132: 689-694.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Rosen M., Brody F., Walsh RM, Ponsky J. Hand-assisted laparoscopic splenectomy versus conventional laparoscopic splenectomy in cases of splenomegaly. Arch Surg. 2002;137:1348-1352.[Abstract/Free Full Text]
• Smith L., Luna G., Merg AR, McNevin MS, Moore MR, Bax TW Laparoscopic splenectomy for treatment of splenomegaly. Am J Surg. 2004;187:618-620.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Owera A., Hamade AM, Bani Hani OI, Ammori BJ Laparoscopic versus open splenectomy for massive splenomegaly: a comparative study. J Laparoendosc Adv Surg Tech A. 2006;16:241-246.[CrossRef][Medline] [Order article via Infotrieve]
• Wang KX, Hu SY, Zhang GY, Chen B., Zhang HF Hand-assisted laparoscopic splenectomy for splenomegaly: a comparative study with conventional laparoscopic splenectomy. Chin Med J (Engl). 2007;120:41-45.[Medline] [Order article via Infotrieve]
• Grahn SW, Alvarez J. 3rd, Kirkwood K. Trends in laparoscopic splenectomy for massive splenomegaly. Arch Surg. 2006;141:755-761.[Abstract/Free Full Text]
• Gu J., Bo XF, Xiong CY, et al. Defining pelvic factors in sphincter-preservation of low rectal cancer with a three-dimensional digital model of pelvis. Dis Colon Rectum. 2006;49:1517-1526.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Marescaux J., Rubino F., Arenas M., Mutter D., Soler L. Augmented reality-assisted laparoscopic adrenalectomy. JAMA. 2004;292:2214-2215.[Free Full Text]
• Targarona EM, Espert JJ, Cerdan G., et al. Effect of spleen size on splenectomy outcome. A comparison of open and laparoscopic surgery. Surg Endosc. 1999;13: 559-562.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Targarona EM, Balague C., Cerdan G., et al. Hand-assisted laparoscopic splenectomy (HALS) in cases of splenomegaly: a comparison analysis with conventional laparoscopic splenectomy. Surg Endosc. 2002;16:426-430.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Targarona EM, Espert JJ, Bombuy E., et al. Complications of laparoscopic splenectomy. Arch Surg. 2000;135: 1137-1140.[Abstract/Free Full Text]

Surgical Innovation, Vol. 14, No. 4, 243-251 (2007)
DOI: 10.1177/1553350607311088


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Berindoague, R. Articles by Trias, M. Search for Related Content PubMed PubMed Citation Articles by Berindoague, R. Articles by Trias, M. Pubmed/NCBI databases Medline Plus Health Information Endoscopy Social Bookmarking                         What's this?